The management and leadership of nurse managers in top positions within health care

Abstract: The aim of this thesis was to illuminate the management and leadership of nurse managers within Swedish health care organizations and to recognize influencing factors of importance for the nurse managers in exercising and developing their management. The interviewees were all active in their positions at the time of the interviews. The nurse managers served at top management levels in either executive or staff positions. The results are based on open-ended interviews with nurse managers (n=30), chief physicians (n=11), hospital directors (n=3) and politicians, chairmen of the local health board (n=3) in three Swedish cities. A number of nurse managers (n=205) from all over the country answered a self-reported questionnaire focusing on professional/social networks, job/social support, demand/control at work and self-rated health. Data were analysed through qualitative and quantitative methods. Power was the overall factor and was related to power within the organization, acceptance in power position, and freedom to act. Four different leadership styles were identified among the nurse managers, which were directed towards the formations of hierarchical authority, hierarchical adjustment, career approach and devotional approach. Nurse managers with a composite leadership style experienced more management problems than nurse managers with a clear leadership style. There was a change in management direction and role from operational level towards adjustment and development levels in nurse managers over a period of three years. Nurse managers who completed a post basic education increased their management focus in relation to research and nursing development. Nurse managers who worked full-time in leading positions for a period of three years increased their communication channels outside health care and distributed power down the organization. Nurse managers with high demand at work in combination with low job support, low emotional support and with no affiliation to professional network showed increased odds for low self-rated health. Nurses in management position constituted a group under pressure influenced by traditional hierarchical power structure, with a high demand at work in relation to changing processes within health care organizations.